'It's Better to Die From One Bullet Than Being Slowly Killed Every Day' - The Cruel Fate of Refugees Forsaken in Nauru

Landing on Nauru I felt like the plane was about to hit the ocean - the tiny island is smaller than most of the airports I travel through. The scenery is unwelcoming, with most of the inland areas devastated by decades of phosphate mining. Heat, dust and wild dogs follow you everywhere.

Having worked in most of the world's conflict zones over the last 15 years, I thought I had learned enough about suffering, injustice and despair. But what I saw and heard on Nauru will haunt me forever.

Three years ago, Australia decided to banish refugees who attempted to reach its shores by boat to Nauru. Since then, hundreds of men, women and children have been stuck on this remote island in appalling conditions; many, if not most, are suffering from serious physical and mental ailments. Their futures are completely uncertain.

The Australian and Nauruan governments know very well how horrendous and unlawful everything that goes on here is, and go to great lengths to hide it. Almost no journalists or independent observers have been able to come to Nauru since refugees started arriving four years ago.

What's even more sinister is that everybody who works for the Australian government here is sworn to secrecy - under Australian law, service providers face two years in jail if they reveal anything about the situation in Nauru. My human rights work has taken me to many "closed" countries and regions, including China, Uzbekistan, Chechnya, northern Sri Lanka and Bahrain, but I've never seen such a sustained - and successful - effort to hide abuse from the outside world.

On this island there are around 1,200 people who have faced terrible hardship and oppression in Afghanistan, Myanmar, Iraq, Somalia, Iran and many other places. They have fled civil war and abusive governments, endured excruciatingly difficult journeys across the world, and eventually braved the high seas in beaten-up boats to reach a country which they heard could offer freedom, peace, and respect for their rights.

But Australia dashed their dreams. Instead of giving them protection and refuge, as international law and the most basic principles of humanity require, its government has decided to use these people to deter further maritime arrivals, by treating them in the worst possible way.

The despair on Nauru is palpable. Although around 70% of the people sent there have been recognised as refugees, they have nowhere to go. Australia has said it will never accept them, but hasn't offered them any viable alternatives. Even those who have received Nauruan travel documents cannot leave: the documents state "refugee" as their nationality and those who have tried to use them to get visas to go to other countries have quickly realised they are useless.

Initially, people were told they were being sent to Nauru "for six months" of processing. Three years later, they feel deceived and forgotten. As one man told me:

"In many ways, this is worse than prison: at least in prison, you know what you've been jailed for and how long you are serving. And you have a chance to get out."

For many months after arriving here, people were confined in a detention centre. They lived in mouldy tents in appalling, prison-like conditions, waiting in long lines for food and toilets and forbidden from bringing food into their tents for their children. Guards conducted regular searches of their tents, confiscating items like sewing needles, disposable shaving razors, and cosmetic tweezers. Showers were limited to two minutes, after which the guards would simply switch off the water and force people out, with shampoo in their hair and their bodies covered in soap.

All but 400 people have since been provided with accommodation in Nauruan communities, and their living conditions have improved somewhat. But there are new, more serious struggles. Many people, especially women, told me that they face daily humiliation, sexual assault and other harassment, and attacks from the local population.

Dalileh*, who fled Iran with her husband and ended up in Nauru in the summer of 2013, told me how, last year, she woke up in the middle of the night because she heard voices outside. She went out, fearing that local thieves had come again to steal clothes and shoes left outside.

"The next thing I remember was a strong blow on my head, and two men running away. Blood was streaming down my face," she said.

An ambulance took Dalileh to hospital where doctors put eight stitches in her head, and police later found the metal bar she was hit with. However, when Dalileh and her husband tried to report the incident, the police refused to open a case, suggesting, incredibly, that "maybe Dalileh had hit herself".

Almost everybody I met on Nauru, including young children, had health problems. Many were extremely serious - heart attacks, rapidly deteriorating diabetes, lumps in breasts, various infections and broken bones. Refugees said they had been seeing local doctors as well as the ones contracted by the Australian government but had received no proper treatment. Disturbingly, people have not been able to obtain their medical records despite repeated requests - instead, they've been given heaps of pills which many said had made their conditions worse.

"In order to be transferred for treatment to Australia, you basically need to be dying," one man said. "Otherwise, they keep saying it's not bad enough to justify a medical transfer."

Another man suffering from multiple medical problems said: "I thought I escaped death. But now I start to think that it's better to die from one bullet than being slowly killed every day, over three years."

One of the most shocking aspects of the situation in Nauru is the prevalence of mental trauma, self-harm and attempted suicides. Every other witness I spoke to had either attempted suicide or was thinking about it.

Faraz*, an art teacher from Iran, came to Nauru with his wife and 10-year-old son. He said that his wife had been very depressed from the moment they arrived and had got much worse over the past year, especially after their house was attacked twice by locals. Two months ago he went out for a smoke and came back to find his wife unconscious, with empty pill packets around her bed. Doctors managed to save her, but in hospital, and during the two months that she spent in a psychiatric ward in the camps, she persistently tried to end her life - swallowing pills or shampoo, hanging herself with bedsheets, and cutting her veins with a plastic knife.

"When I visited her, I was going crazy myself - I saw bruises and scratches on her arms: they were forcibly giving her food and medication, and were dragging her into the shower and toilet with her hands tied," said Faraz.

"And when I asked the doctor, he said that was the treatment plan. I couldn't take it anymore, and brought her back home... My son is so deeply traumatized, he doesn't go out anymore; he just stopped doing anything. I feel I am losing my family in front of my eyes, and worst of all, there is nothing I can do about it."

Even children have attempted suicide. Ali* told me that he fled Afghanistan with his two teenage sons after his family suffered regular threats and attacks by the Taliban - his brother-in-law was killed and his wife died shortly after. But it is now, on Nauru, that he is most worried about his boys. The younger one has already tried to kill himself several times.

"I am trying to hide everything in this tiny room - pills, knives. And I am not letting him out, because I am afraid he will do something to himself," Ali said.

Perhaps torture is the worst, most traumatic thing I've documented in my human rights work: it is very difficult to ever fully recover from the physical suffering combined with absolute loss of control. But on Nauru I realised that there is something even worse. People who are deliberately driven to the absolute depths of despair, inflicting suffering akin to torture on themselves because they feel it is the only way to get heard.

There can be no justification or forgiveness for a system that does this to people - it is time for Australia and Nauru to end this offshore horror.

Anna Neistat is the Senior Director of Research at Amnesty International